Psychedelics as therapy

Research shows that hallucinogens can be highly effective treatments for anxiety, depression, addiction, and trauma. Here's everything you need to know:

Aren't psychedelic drugs illegal?

Under federal and most states' laws, they are, but a push to legalize or decriminalize the drugs is gaining momentum. On Election Day, Oregon voters made their state the first to legalize the active ingredient in "magic mushrooms" — psilocybin — for mental health therapy in a controlled setting with a therapist. Washington, D.C., voters passed Initiative 81, making the city at least the fifth to decriminalize magic mushrooms. Similar legislation has been proposed in California, Vermont, and Iowa. Last summer, Canada issued four terminally ill patients exemptions to take psilocybin for end-of-life anxiety and depression. British Columbia resident Mona Strelaeff, 67, got an exemption for treatment for trauma, addiction, depression, and anxiety. "All the unresolved trauma," Strelaeff said, "it came back and I was beyond terrified, shaking uncontrollably, and crying." She said that psilocybin therapy helped her conquer "those tough memories" and today she "ain't afraid of jack (s---)."

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How does psychedelic therapy work?

Participants usually take psilocybin or LSD in a relaxing setting, lying down with blindfolds and headphones on, listening to music. Trained supervisors encourage them to "go inward and to kind of experience whatever is going to come up," said Alan Davis, who studies psychedelics at Johns Hopkins University. Bad psilocybin trips are rare — Johns Hopkins and NYU researchers conducted 500 sessions without observing any "serious adverse effects" — but they can occur. Advocates say careful dose control, supervision, and controlled settings are very important. Psilocybin sessions typically last between four and six hours, while LSD sessions go on for 12. Robin Carhart-Harris, who runs the Centre for Psychedelic Research at Imperial College in London, theorized that such sessions can "reboot" the brain in a way similar to a near-death or intense spiritual experience.

What's the neuroscience?

Psychedelics have been shown to stimulate new brain cell growth and create more complex connections that enable various far-flung areas of the brain to communicate with one another. Habitual, rigid patterns of thinking are broken. At the same time, these drugs temporarily dissolve the ego — the sense of separation of the self from everything else — and produce an "oceanic" feeling of oneness with the universe, which is why many indigenous societies have used them in spiritual practices. "I didn't know where I ended and my surroundings began," one patient told Michael Pollan, author of a book on psychedelic therapy, How to Change Your Mind.

Why does the ego disappear?

Experiments have shown that psychedelics diminish blood flow and oxygen consumption in an area of the brain called the default mode network, or DMN. The DMN, which scientists have nicknamed the "me network," acts as a gatekeeper for consciousness, filtering out information so that the brain can operate more efficiently. As the DMN gets turned off, people experience a sudden opening of the gates of perception, ideas, and visions, with vivid hallucinations that give participants new insights into themselves and into life itself.

What are the benefits?

Researchers say they can be profound and wide-ranging. One 2014 Johns Hopkins study found that 80 percent of smokers who underwent psilocybin-assisted therapy reported that they remained smoke-free six months afterward. "The universe was so great, and there were so many things you could do and see in it that killing yourself seemed like a dumb idea," one smoker told Pollan. A 2016 study reported that 83 percent of cancer patients with depression and anxiety enjoyed profound increases in life satisfaction or well-being from a single psilocybin dose. About two-thirds of study participants ranked the therapy among the "top five spiritually significant" events in their lives. One professed atheist recalled feeling "bathed in God's love." Fear of death often disappears.

Why are these drugs illegal?

During the 1950s, some psychologists thought psychedelics could revolutionize mental health treatment. But when recreational use of these powerful substances became popular among hippies in the 1960s, it sparked a backlash, with tales of bad trips and psychotic breaks. In 1965, the federal government banned psychedelic drugs, and the companies stopped producing them for research. Timothy Leary, the rebel psychologist who encouraged youngsters to "turn on, tune in, and drop out," was branded "the most dangerous man in America" by President Richard Nixon. But after decades of underground use, research into their value has experienced a renaissance. In 2018, the FDA designated psilocybin as a "breakthrough therapy" for depression and anxiety. A year later, Johns Hopkins University launched the Center for Psychedelic and Consciousness Research — the same year that Imperial College in London launched its center. "The hoary '60s platitude that psychedelics would help unlock the secrets of consciousness," Pollan says, "may turn out not to be so preposterous after all."

Studying MDMA and DMT

Other psychedelics besides LSD and psilocybin have shown therapeutic promise. MDMA, long known as the club drug "ecstasy," or "molly," interacts with many of the same neurotransmitters in the brain as conventional anxiety drugs. Studies show it inspires feelings of "empathy and bonding" that can be incorporated into everyday life with the help of a therapist. Researchers at the Santa Cruz, California–based Multidisciplinary Association for Psychedelic Studies have already concluded Phase 2 trials of MDMA-assisted psychotherapy for use in treating PTSD, and are planning Phase 3 trials. Studies have found that ayahuasca, a psychoactive brew of several plants from the Amazon, can also have beneficial effects. Imperial College is studying how DMT, or dimethyltryptamine, known as the "spirit molecule," can help patients suffering from depression and anxiety. During the very intense 20-minute sessions on the drug, "[patients] kind of go on a journey into themselves," said Dr. Carol Routledge. "Sometimes it can be a bit traumatic." Painful, repressed memories and their connection to current problems can be revealed. Routledge and other therapists strongly advise against experimenting with psychedelic substances outside of a controlled setting, warning that the experiences can be overwhelming.

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